Title page, table of contents and summary only. The complete thesis in print form is available from the University of Adelaide Library. / I hereby submit a body of original research for consideration of the award of Doctor of Medicine from the University of Adelaide. This is a collection of published original research that has made substantial contributions to the modern diagnosis and management of breast cancer. The publications have been presented in three clusters, each of which represents one facet of the modern approach to the diagnosis and management of breast cancer. The first section presents my publications on the theme of population based mammographic screening for the early detection of breast cancer. Broadly, the research focus in these publications is on the evaluation of existing methods of assessment of screen-detected breast lesions in order to improve diagnostic accuracy and limit the morbidity associated with mammographic screening. The clinical value of these contributions has been demonstrated independently since this body of work has informed many of the algorithms and protocols used by the South Australian breast cancer screening program. In addition, the protocols have been adopted for use outside of the screening setting into the wider diagnostic arena. The clinical endorsement of my research contributions is a significant acknowledgement of their practical value. The middle group of publications describe my contributions towards the evolving role of sentinel node biopsy as an alternative to axillary clearance for the staging of breast cancer. This area is of particular cogent to our setting, since a large proportion of screen-detected breast cancers, approximately 80%, are node negative. Thus, avoidance of the morbidity of axillary clearance while still achieving accurate axillary staging is of enormous appeal to our patients. My pioneering work in devising and evaluating protocols for the pathologic examination of sentinel nodes has informed the recommendations of the NHMRC sponsored SNAC (Sentinel Node versus Axillary Clearance) randomised trial. Consequently, these protocols have been used extensively and even outside of the trial setting, most pathology laboratories utilise similar assessment protocols as was recommended in SNAC. Furthermore, the United Kingdom's recommendations for the pathology examination of sentinel nodes have drawn on our research. After validating the concept of SNs in breast cancer, many of the clinically important questions emerging in this field have been addressed by our team. For example, my work on intra-operative imprint cytology was a conclusive demonstration of the value and limitations of this technique for one stage axillary surgery. In the light of our findings intra-operative assessment of sentinel nodes has been expanded to many centres and is endorsed by the SNAC trial. In the third section of this thesis, my contributions to the rapidly evolving field of molecular and genetics of breast cancer are highlighted . Through the Australian HER2 Advisory Board, we have led the evaluation and roll out of alternative platforms for HER2 testing and in developing algorithms for the efficient use of resources. We have devised national testing algorithms in both settings of metastatic and early breast cancer. These algorithms have since been utilised by the international HER2 testing bodies. In a further bold initiative, our group pioneered the move to the national adoption of bright field In situ hybridization as the first line testing platform for all newly diagnosed breast cancers throughout Australia. This ambitious undertaking entailed design and implementation of a nation-wide program of training, certification, quality assurance and evaluation. It has been deployed successfully and under my leadership, our laboratory was one of only four laboratories in Australia to commence this test in October 2006. Similarly, in the area of the genetics of breast cancer, my interest in this field and membership of the pathology subcommittee of KCONFAB has provided opportunities to contribute to significant new knowledge that illustrate the role of pathology in identification of mutation associated breast cancers. Under my leadership, our multi-centre studies have provided cogent arguments in favour of the inclusion of the histopathologic and immunophenotypic characteristics of breast cancers in the triage of patients for genetic testing. These results were published in pre-eminent pathology journals and have been referred to at major scientific conferences. Plans are afoot for the future extensions of this work. I am committed to utilising my expertise for the provision of high quality diagnostic services as part of a multi-disciplinary team involved in the treatment of women with breast diseases. I believe an evidence-based approach is central to achieving continuous improvements in these efforts. I am persuaded that there is substantial evidence demonstrating the value of population based mammographic screening in interrupting the natural history of breast cancer and reducing mortality from this disease. I am grateful to have the opportunity to contribute to the provision of this care. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1473394 / Thesis (M.D.) -- University of Adelaide, School of Medical Sciences, 2010

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The topic of health is currently very up-to-date and the need for population health promotion and disease prevention is becoming increasingly important. The consequences of neglecting prevention and health promotion on the state's economy are clear, whether it is about increasing public spendings on health care or indirect effects on the level of human capital. The aim of this work is to analyze health promotion in the Czech Republic with a focus on mammographic screening programme introduced in 2002. The study demonstrates a decrease in breast cancer mortality following the screening examination and an increase in the number of tumor findings in earlier stages of the disease. It also analyzes the effect on costs of health care and the impact of screening on them. It also proposes to extend preventive screening examinations to other areas where their implementation could be useful in the future.

The subject of this thesis is to identify and quantificate costs of Breast Cancer Therapy. The goal is the quantification of costs for specific therapeutic modalities, which are used by the therapy. Obtained values are used for presentation of the cheapest and the most expensive mode of treatment.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2015-07-27T13:39:57Z No. of bitstreams: 1 Renata Mara Bueno Aguiar.pdf: 3052806 bytes, checksum: 7fc933a7df31cf76bd53ddfab6dc00d3 (MD5) / Made available in DSpace on 2015-07-27T13:39:57Z (GMT). No. of bitstreams: 1 Renata Mara Bueno Aguiar.pdf: 3052806 bytes, checksum: 7fc933a7df31cf76bd53ddfab6dc00d3 (MD5) Previous issue date: 2013-12-11 / Objective: To analyze the mammographic radiologic findings during screening campaigns of a Brazilian Oncology Center. The mammographic radiologic findings, the complementary diagnostic tests eventually requested and the patient’s adherence to the screening recommendations were studied. Methods: A retrospective study was conducted including all 771 patients that participated in the stimulated and gratuitous screening program of the A. C. Camargo Cancer Center, São Paulo, Brazil, during 2008. The patient’s records were analyzed in order to obtain result from mammography tests, breast ultrasonography, biopsies and surgeries. Results: The women`s age varied from 24 to 107 years old. (average: 55 years old), 259 (34%) under 50 years old, 423 (55%) between 50 and 69 years old and 89 (11%) older than 69 years old. The mammography results were classified as follows: BI-RADS 0 =186 (25,1%), BI-RADS 1 = 114 (14,8%), BI-RADS 2 =395 (51,2%), BI-RADS 3 =50 (6,5%), BI-RADS 4 = 16 (2,1%) e BI-RADS 5 =2 (0,3%). Complementary ultrasonography exam was performed in 184 (24%) of all patients. Thirty three (4%) lesions were submitted to histopathological analyses revealing 6 (8%) cases of cancer. They were 3 invasive ductal carcinomas, 2 in situ ductal carcinomas and 1 lobular carcinoma in situ. Five of those cancers were surgically classified as Stage 1 disease and One as Stage 2 disease. After 4 years 87 (15%) patients returned for new screening exams. Conclusion: There was a meaning ratio of patients out of Brazilian National Cancer Institute (INCA) recommendation for breast cancer screening. The rates of complementary ultrasonography were high. The number of patients diagnosed with cancer and the rates of diagnoses in initial grades are in consonance with the literature. The opportunistic screening model revealed low return rate for new screening tests. / Objetivo: Analisar durante uma campanha de rastreamento para câncer de mama realizada em um Centro Brasileiro de Oncologia. Foram estudados os achados radiológicos das mamografias e as eventuais recomendações de testes diagnósticos complementares e a adesão das pacientes a essas recomendações. Metodologia: Esta foi uma análise retrospectiva incluindo todas as 771 pacientes que participaram das campanhas estimulada e gratuita de rastreamento para câncer de mama do A. C. Camargo Cancer Center, em São Paulo, Brasil, no ano de 2008. Foram avaliados os resultados de mamografias, ultrassonografias, biópsias e cirurgias de mama realizadas. Para os diagnósticos de câncer registramos a histologia e o estadiamento clínico da doença. Resultados: A idade das mulheres variou de 24 a 107 anos (média: 55 anos), 259 (34%) com idade inferior a 50 anos, 423 (55%) com idade entre 50 e 69 anos e 89 (11%) com idades maiores que 69 anos. A classificação segundo o BI-RADS do resultado das mamografias foi: BI-RADS 0 186 (25,1%), BI-RADS 1 114 (14,8%), BI-RADS 2 = 395 (51,2%), BI-RADS 3 = 50 (6,5%), BI-RADS 4 =16 (2,1%) e BI-RADS 5 = 2 (0,3%).O exame ultrassonográfico complementar à mamografia foi realizado por 184 (24%) da amostra. Foram realizadas 33 (4%) investigações anátomo-patológicas identificando 6 (8%) casos de câncer, 3 Carcinomas ductais invasivos, 2 carcinomas ductais in situ e 1 carcinoma lobular in situ. O estadiamento cirúrgico dessas neoplasias foi Estadio 1 para 5 pacientes e Estadio 2 em uma paciente. A revisão dos registros realizada após 4 anos identificou 87 (15%) pacientes que haviam retornado ao serviço para novos exames de rastreamento ao menos uma vez. Conclusão: Uma proporção significativa das pacientes de campanha está fora da faixa etária de recomendação do Instituto Nacional do Câncer do Ministério da Saúde (INCA) para rastreamento do câncer de mama. As taxas de complementação com ultrassonografia foram elevadas. O número de cânceres e a taxa de diagnósticos em estádio inicial estão em consonância com os índices preconizados. O modelo de rastreamento oportunístico mostrou baixa taxa de retorno periódico ao mesmo serviço.